Top 10 blogs of 2017: Debating the merits and potential consequences of Trumpcare
The most-read blogs of 2017 reflect a year of staying the course amid uncertainty over the outcome of health reform efforts. Contributions weighing the growing impact of technology on ben admin were intertwined with speculation about how Affordable Care Act repeal-and-replace legislation could alter employee benefit plans and the ever-elusive quest to get employees to save more for retirement.
Joe Markland argued that when it comes to adopting new technology, simple is better than complex.
“Current technology trends continue the move toward simplicity with the advent of artificial intelligence and personal assistants like Amazon’s Echo and the Google Home. Before you know it, these tools will enter the benefits world. The question is, who is going to be first and best? Also, if I am a benefit broker, what is the impact to my business?” Markland asked.
Katy Stowers argued that lost in much of the public debate around the House of Representatives’ ultimately failed bill was the potential impact on employers.
There were beneficial aspects of the bill, she said:
1) Repeal of the tax penalties related to the employer mandate.
2) A delay of the Cadillac tax until 2025.
3) Expansion of tax savings vehicles, such as individual health savings accounts and health flexible spending accounts.
4) Elimination of taxes on medical devices and health insurers.
5) A likely end to the ACA’s complex and burdensome employer reporting requirements.
Daniel N. Kuperstein said repeal of the ACA would be President Donald Trump’s first priority. However, he accurately predicted the difficulty of fulfilling the campaign promise: “Economists and lawmakers that have been deeply involved in U.S. healthcare policy have noted that repealing the ACA will be an extremely difficult task.”
In breaking down the Congressional Budget Office’s assessment of the proposed American Health Care Act, Joel Wood zeroed in on the CBO’s estimate that 2 million fewer Americans will have employer-sponsored coverage in 2020, growing to seven million by 2027.
But, he gave reason for optimism, noting, “The CBO said much the same about the Affordable Care Act, which largely didn’t happen. And CBO notwithstanding, we at the Council of Insurance Agents & Brokers, too, feared something of a death spiral after the ACA was enacted.”
In a time of “dismal options,” Paul Johnson said, “it’s no surprise the healthcare dilemma has created a culture of aggravation and cynicism among employers.” The solution, he said, is in advisers becoming stronger advocates for self-insurance. Among other benefits, Johnson said the benefits model is more likely to reduce costs, mitigate workers’ comp issues and give employers ownership of plan data.
Peter R. Siegel recapped a series of “dramatic changes” that took place in existing labor and employment laws, breaking down how advisers should prepare businesses for the year by highlighting these employment-related developments, including overtime changes, marijuana at work, transgender discrimination and social media policies.
In four categories — plan design, contributions, employee education and investments — Robert C. Lawton explained the features of a successful retirement plan.
Robert C. Lawton reflected on ways tax reform could have better addressed retirement savings. “Limiting pre-tax 401(k) contributions would have actually pushed participants to contribute more to their retirement plans. In fact, a much higher cap on Roth 401(k) contributions could provide a way for Americans who haven't contributed enough in their early years to catch up,” he said.
Zack Pace argued that the structure and operation of Section 125 plans “is one of the hardest things for employers to master.” He highlighted top misconceptions about the plans, including false beliefs that employers do not need a plan document in place, that TPAs are experts on Section 125 and that all who are eligible under the health plan may participate.
On Inauguration Day, Craig Hasday said the No. 1 question his clients’ minds was how the new administration would impact their benefit plans. He offered five predictions:
1) Since the employer mandate will disappear, so will minimum essential coverage plans. If they were only offered because the employer had to do so, the employers will discontinue these as soon as they can.
2) 1094/1095 reporting will stop, but it is probably too late to stop this year’s upcoming requirement. Good riddance — what a waste of time and resources.
3) The Cadillac tax will be a thing of the past. Congress will seek to pay for indigent care by limiting the individual exclusion for healthcare benefits provided by employers. This will further facilitate the shift to high-deductible plans.
4) Medicare will not change. The politics on this are a losing battle for whoever takes it on. The Democrats’ “Medi-scare” tactics will force Republicans to back off
5) Drug costs are going to come down. While pharma is a powerful lobby, this issue has too much momentum. Whether it’s reimportation or transparency laws, something is going to give.